Heightened Cardiovascular Risk in Diabetic Women: Can the Tide Be Turned?

The diabetic woman is at heightened risk for all-cause, cardiac, and coronary heart disease (CHD) mortality. So concluded the authors of a 1999 study of sex-specific comparisons of enrollees in the First National Health and Nutrition Examination Survey (NHANES I) (1971–1975) and the NHANES I Epidemiologic Follow-up Survey (1982–1984) (1). The aim of the study was to determine age-adjusted cardiac mortality rates in 2 time periods by using 2 cohorts from the NHANES I national probability sample. One cohort was followed from 1971 to 1974 for a mean of 9.1 years, and the other was followed from 1982 to 1984 for a mean of 8.7 years. Compared with cardiac mortality in the 1971–1974 cohort, cardiac mortality in the 1982–1984 cohort declined by 36.4% in nondiabetic men, 13.1% in diabetic men, and 27% in nondiabetic women—but increased by 23% in diabetic women.

An article in this issue (2) underscores the diabetic woman's continued heightened risk for both all-cause and cardiac mortality. Gregg and colleagues compared all-cause and cardiovascular mortality rates in adults with and without self-reported diabetes from the NHANES I (1971–1975), II (1976–1980), and III (1988–1994) cohorts as determined through 1986, 1992, and 2000, respectively. Cardiovascular deaths declined over the 3 decades in diabetic (26.4, 17.1, and 12.8 deaths per 1000 persons per year, respectively) and nondiabetic men (9.6, 6.5, and 4.7 deaths per 1000 persons per year) and in nondiabetic women (4.7, 3.1, and 2.3 deaths per 1000 persons per year) but remained essentially unchanged for diabetic women (10.5, 9.1, and 9.4 deaths per 1000 persons per year). The authors concluded that diabetic women have not benefited from the changes that dramatically improved the cardiovascular disease outlook for others.

The results of these 2 studies are difficult to explain. The decline in CHD deaths …